Dermatology-Peckham Flashcards
What is a common pediatric virus caused by the poxvirus?
Molluscum Contagiosum
Which population is commonly affected by molluscum contagiosum?
Young children, sexually active adults and immunosuppressed
Where does the molluscum contagiosum virus replicate?
Epithelial cells
Molluscum contagiosum is spread by
Direct contact, gym equipment, pools, and autoinoculation
The signs and symptoms of molluscum contagiosum include
Non itchy flesh colored dome shaped papule, present mostly over the face, trunk. extremities, and groin
What can be a differential diagnosis for molluscum contagiosum?
Warts and milia
The best way to treat molluscum contagiosum is how?
To avoid autoinoculation, topical cantharadin, and cryotherapy
What type of virus causes non genital verruca (warts)
HPV
What is another name for the common wart?
Veruca Vulgaris
A typical location for veruca vulgaris is
Hands, palms and periungul, nail folds
Clinical manifestations of veruca vulgaris include
Ages 5-20 most common, risk with frequent water exposure, can be >1cm, papules with GREYISH surface
The flat wart can also be called
Verruca Plana
Verruca plana commonly affects who?
Children and young adults
Clinical manifestations of verruca plana include
2-4mm flat topped FLESH COLORED papules grouped on the face, neck, wrists, hands
Another name for the plantar wart is what?
Verruca Plantaris
Verruca Plantaris classically appears where?
Soles of feet, mostly on pressure points (ball of foot or heel)
Which wart is known to group together and look like a “mosaic”?
Verruca Plantaris (plantar warts)
What are some common treatment options for warts (all kinds)
65% resolve w/in 2 years, cryotherapy, salicylic aid/cantharidin, occlusive dressing, intralesional injection of Bleomycin
Bleomycin
Last resort treatment, typically for someone who is immunocompromised and has multiple warts all over. Effective, not commonly used
What are dermatophyte infections?
Superficial fungi that germinate on the dead outer horny layer of skin
Demartophyte infections lead to what?
Epidermal scale (tinea pedis, tinea versicolor), thickened crumbly nails (onychomycosis), and hair loss (tinea capitis)
Where is tinea versicolor common?
In very humid climates
What can be some si/sx for tinea versicolor?
hypo or hyperpigmented macules that do not tan, typically asymptomatic
How can you diagnose tinea versicolor?
KOH scraping showing hyphae and spores (spaghetti and meatballs?)
Wood’s light flouresce an orange mustard color
What are the 3 treatment options for tinea versicolor?
- Daily Selenium sulfide shampoo for 15mins x 7days
- Topical Ketoconazole cream daily x 3 weeks
- Oral Ketoconazole 200mg qd x 2 weeks
Tinea Corporis is also known as?
Ringworm
What do the lesions look like in tinea corporis?
Annular with peripheral enlargement with central clearing. Scaly, “active border” asymmetric distribution face, trunk, extremities
Can tinea corporis be itchy?
Yes, can also be asymptomatic
How can you diagnose tinea corporis?
KOH scraping or fungal cultures. Can look similar to lyme dx
What is the treatment for tinea corporis (ringworm)?
Topical antifungals, Naftin or Ketoconazole bid x 2 weeks
Tinea Pedis is common in who?
Young men
What do the lesions look like in tinea pedis?
Scale and maceration in toe web spaces as well as “moccasin” type distribution on plantar surface. Distinct borders
Some si/sx for tinea pedis?
Itchy feet, inflammation and possibly fissures
Is a KOH scraping and fungal culture the proper diagnostic tools for tinea pedis?
Yes
The treatment for tinea pedis includes
Keep feet dry, Miconazole powder, Topical antifungals (Naftin, ketoconazole, lotrimine cream)
If severe: Lostrisone cream x1 week (steroid+antifungal)
What dx involves autoimmune destruction of melanocytes?
Vitiligo
What would be seen with Wood’s light when looking at Vitiligo?
Milky white appearance of the affected areas
How would you treat Vitiligo?
Avoid sun, Cosmetic cover-up, Tacrolimus/Pimcrolimus, Eximer laser
What is the incubation period for Varicella (chickenpox)
10-21 days
How can varicella be transmitted?
by direct contact with lesion AND respiratory droplets
When are individuals with varicella infectious?
For 4 days before and 5 days after appearance of exanthem
Some si/sx for varicella include
rash, malaise, low grade temp
What do the lesions look like in varicella?
Start as faint macules that develop into vesicular eruptions with “teardrop” vesicles on erythematous base
Where does chickenpox start?
On the scalp, face, trunk, then spreads to extremities. Can also appear or palms/soles
When are the lesions in varicella no longer infetious?
When they are crusted over
Which types of microbes can cause secondary complications to varicella?
Staph or Strep
Adults with chickenpox have a higher risk of what?
Pneumonia
What is an important diagnostic tool for varicella?
Tzank smear from the vesiles that show multinucleated giant cells
The treatment for varicella (children <13)
Oatmeal baths, calamine lotion, antihistamines
The treatment for varicella (Adults >13)
Oral acyclovir within 24 hours of onset for 5 days
Immunocompromised: IV acyclovir
Why should you avoid giving aspirin to children with varicella?
REYES SYNDROME (hepatitis and acute encephalopathy)
What is the reactivation of varicella zoster virus?
Herpes Zoster (shingles)
What does herpes zoster cause?
Inflammation in the dorsal root ganglion with hemorrhagic necrosis of nerve cells
The result of shingles is what?
Neuronal los and fibrosis
Is reoccurrence possible with herpes zoster?
Yes, 4% of cases with reoccur
The si/sx of herpes zoster include
Prodrome of pain followed by rash along the affected dermatome
Which dermatomes are affected themost in herpes zoster?
55% throacic, 20% cranial (trigeminal), 15% lumbar, 5% sacral
What are the lesions like in herpes zoster?
Classically UNILATERAL, papules and plaques of erythema that develop into vesicles, can become hemorrhagic or bullous
What is Hutchinson’s sign?
Herpes zoster lesions on the side and tip of the nose. Means opthalmic division of 5th cranial nerve is affected
What complications can happen when herpes zoster affects the opthalmic division of cranial nerve 5?
Retinal necrosis, glaucoma, optic neuritis
Send to ophthalmologist ASAP
The treatment for herpes zoster is
Antiviral therapy (w/in first 3-4 days), Valacyclovir or Famciclovir x 7 days, Prednisone, Domboro Solution, pain management
What is Domboro solution?
Can help with the “wetness” from the bursting vesicles in herpes zoster
How can you prevent herpes zoster?
Zostervax >60yo
What are some complications with herpes zoster?
Post herpetic neuralgia (pain continues past 1 mo)
Refer to neurologist for pain management
HSV-1 causes most cases of what?
Oro-labial herpes
HSV-2 causes most cases of what?
Genital herpes
Initial exposure of herpes is through what?
Direct contact with infected secretions (sexual, autoinoculation, vertical)
Where does HSV-1 commonly reside?
Trigeminal ganglia
Where does HSV-2 commonly reside?
Presacral ganglia
What is the incubation period of herpes?
After exposed, 2-20 days
Herpes simplex can be triggered by what?
Stress, menses, fever, infection, sunlight
You have an increased risk of herpes simplex when..
Number of sexual partners increases, first intercourse is at a young age
Si/sx of herpes simplex
Prodrome of fever, myalgias, malaise
Orolabial herpes simplex si/sx
Tender grouped vesicles/blisters on an erythematous base, ulcerative, exudative “cold sore” lasting 1-2 weeks
Genital herpes simplex si/sx
Grouped blisters and erosions on vagina, rectum or penis into new blisters over 1-2 weeks
Herpetic Whitlow si/sx
Herpes simplex occurring on the fingers or periungually, tenderness and erythema with deep seated blisters
What are some diagnostic tools for herpes simplex?
Fluorescent antibody tests/western blot to differentiate HSV-1, HSV-2, etc.
Tzanck smear for giant nucleated cells
Primary treament for herpes simplex includes
Acyclovir 200mg 5x a day for 10 days
Valacyclovir 1mg bid for 10 days
Suppressive treatment for herpes simplex includes (>9 cases a year)
Acyclovir 400mg bid
Valacyclovir 1gr daily
Recurrent treatmetn for herpes simplex is
Acyclovir 400mg tid x 5 days
Valacyclovir 2mg bid x 1 day
What is paronychia?
Inflammatory reaction involving the folds of the skin around the fingernail, can be acute or chronic
What is the etiology of paronychia?
Acute and chronic begin with break in skin associated with trauma to cuticle (eponychium) or nail fold and maceration of proximal nail fold
Acute paronychia
Aggressive manicure, nail biting. Usually Gram + staph aureus
Chronic paronychia
Frequent handwashing. Usually pseudomonas aeruginose of candida albicans
Acute paronychia symptoms?
Erythema, swelling, pain. Starts as red warm painful swelling around the nail. Can progress to formation of pus
Chronic parynychia symptoms?
Swollen, erythematous tender without fluctuance. Can can become thickened with TRANSVERSE RIDGES, 6 or more weeks
How can you diagnose paronychia?
KOH wet mounts may show hyphae (yeast with chronic paronychia), clinical history and exam!
Treatment for acute paronychia includes what?
Warm water soaks 3-4/day. PO Augmentin 2gr x 5d, topical steroid cream
Treament for chronic paronychia includes what?
Avoid moister , manicuring, etc. Warm soaks, topical steroid cream or antifungal Spectazole
What is onychomycosis?
An infection of finger or toe nails by yeast or fungi
Onychomycosis is common in who?
People with other nail issues (Downs syndrome, nail trauma, immunocomp., vascular insufficeincy)
What do the lesions look like in onychomycosis?
Nail thickening and subungual hyperkeratosis (scale build up) nail distrophy or onycholysis (nail plate elevation form nail bed)
What are some diagnostic tools for onychomycosis?
KOH + fungal/yeast culture
Treament for onychomycosis?
Non treatment acceptable, topical agnets generally ineffective
What agents can be used for onychomycosis?
Topcial: Ciclopirox solution, Efinaconazole solution
Oral: Lamisil (check LFTs before and after) 250qd x 6-12 weeks
Are eczema and dermatitis the same thing?
Yes the terms can be used interchangeably
What are eczematous eruptions?
A family of superficial, pruritic, erythematous skin lesions that can be red, blistering, oozing, scaly, or thickened skin
What is dermatitis?
Inflammation of the skin
What does the term atopic mean?
A lifelong tendency to allergic conditions such as asthma and allergic rhinitis
Manifestations of dermatitis/eczema
Dry, flaky skin appears over red, inflamed areas causing intense itching and burning
What is the most common type of eczema?
Atopic Dermatitis
What type of sensitivity rxn is atopic dermatitis?
Type 1 IgE mediated hypersensitivity rxn
Si/sx of atopic dermatitis
“itch that rashes” presenting on flexor surfaces, neck, eyelids, face, dorsm of hands and feet
How can you describe the lesions in atopic dermatitis?
Papules or plaques, edema, erosion with or without scales or crusting
Atopic dermatitis is characterized by
Flexural lichenification (thickening of skin) with a personal or family Hx of allergic rhinitis, asthma, or atopic derm
The intense itching in atopic derm is because of what?
Mast cells and basophils in the dermis releasing histamines. Itching can be triggered by many things
Hyperkeratosis, acanthosis and excoriation are all common in what skin condition?
Atopic dermatitis
Infantile atopic derm commonly presents where on the body?
Cheeks, chest, neck, extensor/flexor extremities. Tend to by symmetric
Adolescent/Adult atopic derm commonly presents where?
Same areas as childhood plus eyelids, vulvar, scrotal areas
What is different form adolescent/adult atopic derm and psoriasis?
The lichenified plaques less well demarcated than psoriasis (blends into skin better in AD)
What are Dennie-Morgan lines?
Hyperlinear changes under the eyes that occur in atopic dermatitis
What are some other clinical features associated with atopic dermatitis?
Persisnta xerosis (dry skin) and hyperlinear palmar creases
What can be a differential diagnosis for atopic dermatitis?
Contact derm, scabies, and psoriasis
What is the mainstay of treatment for atopic derm?
Topical steroids (applied for short periods of time and stopped when healed)
What do the topical steroids do for atopic derm?
They ahve anti-inflammatory properties and are antimitotic (reduce scale build up)
What is the difference between cream ointment foam or gel?
Cream is preferred but can dry skin out
Ointment and gels are more potent but greasy
Lotions gels foams useful for hairy areas
What are some side effects when using topical steroids?
Skin atrophy/telangectasis, aceneform eruptions (face)
Tolerance can be built up, loss of efficacy
What are two examples of very high potency topical steroids?
- Betamethasone dipropionate
2. Clobetasol
What are two examples of medium potency topical steroids?
- Mometasone
2. Traimcinolone
What are two examples of low potency topical steroids?
- Desonide
2. Hydrocortisone
Which antihistamines can be used for atopic dermatitis?
Hydroxazine (sedating) and Cetirizine (less sedating)
Which topical immunomodulators can be used for atopic dermatitis?
Tacrolimus and Pimecrolimus: Used as an addition/alternative to topical steroids. Good for long term use
What are the non-steroidal options to treat atopic dermatitis?
Crisaborole (PDE-4 Inhib): Doesnt work as well as steroids can be used similarly to topical immunomodulators
What biologics can be used for atopic dermatitis?
Dupilumab injections
What PO antibiotics can be used for atopic derm?
Only use if evidence of @ndary bacterial staph infection
Cephalexin 500mg qid x 10d
What are the si/sx of nummular eczema?
COIN SHAPED pruritic patches and plaques often occurring in clusters
What type of eczema has lesions mainly found on the legs?
Nummular eczema
How can you diagnose nummular eczema?
Clinical appearance and negative results of KOH
What is the course of treatment for nummular eczema?
Triamcinolone cream, if severe use high potency Clobetasol +/- occlusion
What is dyshydrosis?
Wet eczema
What are the vesicles in dyshydrosis caused by?
Inflammation and foci of intercellular edema whcih becomes loculated in skin of the palm and soles
Si/sx of dyshydrosis
Small vesicles appear on hands and feet associated with pruritis
What is the treatment for dyshydrosis?
Cetaphil, emollient barrier creams, gloves and avoidance of irritants, Protopic and Elidel (longterm)
What is Burow’s solution?
An antibacterial astringent used to treat dyshydrosis
Which topical corticosteroids can be used to treat dyshydrosis?
Clobetasol ointment for an acute flare, Triamcinolone or Fluocinonide +/- occlusion
Contact dermatitis is
Acute or chronic inflammatory rxns to substances that come in contact with the skin
An example of irritant contact dermatitis is what?
Diaper rash
An example of allergic contact dermatitis is what?
Poison ivy, nickel
What are the si/sx of allergic contact dermatitis?
Linear pruritic rash at site of contact with itching and burning of affected areas
Differential diagnosis for allergic contact dermatitis
Herpes Zoster (this is usually painful and unilateral following dermatomes)
Treatment for allergic contact dermatitis
Remove offending agent, cool showers, Burow’s solution, potent topical steroid, systemic steroid (if severe enough)
What is irritant contact dermatitis?
A direct toxic rxn to rubbing, friction or maceration or to exposure to a chemical or thermal agent
What are some examples of irritants?
Alkalis, acids, soaps, detergents
Diaper dermatitis
Eruptions that occur in the area covered by a diaper. Can affect persons of any age group
What is the patho behind diaper dermatitis?
Over hydration of the skin, irritated by chafing, soaps, prolonged contact with urine and feces
The treatment for diaper dermatitis includes
Zinc oxide ointment and frequent diaper changes, OTC hydrocortisone
Diaper dermatitis differential diagnosis
If beefy red, C. albican is suspected, a topical antifungal Ketoconazole cream with Nystatin powder
Who does perioral dermatitis occur in mostly?
Young women or children
Si/sx of perioral dermatitis
Clustered papulopustules on erythematous bases, may have scales. Found around mouth
Treatment of perioral dermatitis?
Topical antibiotics like Metronidazole or Erythromycin. Doxy or Minocyclin if severe enough
What should be avoided in the treatment of perioral dermatitis?
Topical steroids
What is an eczematous eruption seen on lower legs as a result of venous insufficiency?
Stasis dermatitis
Stasis dermatitis is commonly seen in who?
Women with genetic predisposition to vericosities
What is the patho behind stasis dermatitis?
Incompetent valves -> dec venous return -> increased hydrostatic pressure-> edema -> tissue hypoxia
What can stasis dermatitis develop into?
Hyperpigmented changes with thickened skin and “woody” appearance, ulcers
Elastic compression stockings are the best treatment for what?
Stasis dermatitis
What other things can be used to treat stasis dermatitis?
Burrow’s solution, Desonide and Triamcinalone cream (topical steroids), Keflex for any 2ndary infections
Which type of dermalytitis is thought to be caused by yeast P. Ovale?
Seborrheic dermatitis
Si/sx of seborrheic dermatitis
Pruritis yellowish gray scaley macules with greasy look mostly on body folds, face, scalp
What is the treatment for seborrheic dermatitis?
Zinc shampoo and Ketoconazole shampoo for the scalp
Low potency topical steroids (Desonide or Valisone cream) for the face
Lichen simplex chronicus is also known as?
Neurodermatitis
What is chronic, solitary, pruritic ezcematous eruption caused by repetitive rubbing and scratching?
Neurodermatitis
What is the distribution of lichen simplex chronicus
nape of neck, vulvae, scrotum, wrists, extensor forearms, ankles, pretibial areas, groin
Possible differential diagnosis for lichen simplex chronicus?
Tinea cruris and candidiasis, inverse psoriasis
Treatments for lichen simplex chronicus
Int. strength topical steroids (Triamcinolone), occlusion, oral antihistamines, Protopic and Elidel
